Health Inequalities in Japan: An Empirical Study of Older People (review)

Japan is no longer seen as one of the world’s exceptions. Once it was an industrial society notable for steady economic growth, great achievements in health, low levels of inequality, and a highly functioning social welfare system. Today, it faces issues shared by all industrial democracies: constrained resources exacerbated by the global economic slowdown, growing social inequality, and major demographic shifts. Yet the way that Japan is coping with these shared burdens continues to be highly relevant.

This is particularly true in confronting the challenges of the aging society, in which Japan has been leading the way for four decades. The Japanese government identified the emerging trend in the 1970s, a time when 7 per cent of the population was over age 65.¹ The percentage of the population over 65 is now projected to be 30 per cent by 2020 (it is currently just over 24),² and the problems posed by aging influence a range of social policies, including transportation, health care, pension reform, and even the attention paid to routine medical screening. Japan’s transformation to an aged population was compressed, in part because of the dramatic baby boom immediately following World War II, which created a visible “bulge” in the population pyramid. The increasingly top-heavy shape of the population pyramid has been exacerbated by the growing longevity of Japanese citizens (the Ministry of Health, Labor, and Welfare reports average life expectancy of 79.6 years for men and 86.4 years for women in 2010, the longest in the world) and by the steadily declining birthrate since the baby boom ended (the total fertility rate is under 1.4 births per woman). Now, the individuals who comprised that bulge (largely born between 1945 and 1952) are over 65 years old and no longer contribute to the savings and investments that helped build the industrial resources of the country; instead, they draw down their savings and depend on pensions and health care coverage provided by the steadily declining proportion of the population that is still in its productive years.

Health Inequalities in Japan offers a perspective on various facets of the aging problem, anchored by new data. The essays tend to be short on interpretation and social analysis, instead offering a trove of summary statistics, correlations, and statistical analyses (the book includes 72 tables and 43 figures). The book is nonetheless a valuable contribution and includes a helpful foreword by Ichiro Kawachi of the Harvard School of Public Health with an overview of health care issues in Japan and a series of short boxes scattered throughout that explain conceptual and methodological details. The “aging society” (kōreika shakai) has generated a substantial literature in Japan produced by gerontologists, economists, sociologists, gender studies scholars, and others (as well as an abundance of government policy papers); however, very little of this literature has been translated into English, despite the relevance of Japan’s predicament for the rest of the industrialized world. All in all, though, the volume is likely to be consulted in its entirety largely by epidemiologists and gerontologists.

The volume is comprised of 13 quantitative studies which draw on a major data set, the Aichi Gerontological Evaluation Study (AGES), a survey of 32,891 aged individuals living in 18 municipalities across 5 prefectures. In scale, it is one of the larger social epidemiological surveys to have been conducted concerning the precursors to well-being in later life, and it has gotten the attention of gerontologists, sociologists, and policy analysts in Japan. The survey was conducted in 2003 and 2004, with a follow-up in 2006, by an interdisciplinary team of researchers at Nihon Fukushi Daigaku led by Katsunori Kondo (the editor of the present volume).³ It included urban, semiurban, and rural populations with a slight urban bias. The research was funded by the (then) Ministry of Health and Welfare and the Center of Excellence Program of the Ministry of...